This is Going to Hurt: Now a major BBC comedy-drama

I would always feel tremendously proud to say that I worked for the NHS – who doesn’t love the NHS? (Well, apart from the Secretary of State for Health.) It’s unlike any other national asset; no one talks in fond tones about the Bank of England or would think any less of you if you suggested suing Cardiff Airport. It’s easy to work out why: the NHS does the most amazing job and we’ve all benefitted from it. They delivered you when you were born and one day they’ll zip you up in a bag, but not until they’ve done everything that medical science will allow to keep you on the road. From cradle to grave, just like your man Bevan promised back in 1948.

They fixed your broken arm on sports day, they gave your nan chemo, they treated the chlamydia you brought back from Kavos, they started you on that inhaler, and all this wizardry was free at the point of service. You don’t have to check your bank balance after booking an appointment: the NHS is always there for you.*

On the other side of the fence, knowing you were working for the NHS took the sting out of so many things about the job: the vicious hours, the bureaucracy, the understaffing, the way they inexplicably blocked Gmail on all the computers in one hospital I worked at (thanks, guys!). I knew I was part of something good, important, irreplaceable, and so I did my bit. I don’t have an amazing inbuilt work ethic, it’s not applied to anything I’ve ever done since (as my publisher will attest), but the NHS is something special, and the alternative is horrifying.

We should see the skyscraper-high bills of America as the ghost of Christmas future when it comes to NHS privatization. Politicians may act dumb, but they’re not, and we’ll be lured very stealthily into this particular gingerbread house. We’ll be promised it’s only little corners of the NHS that are changing, but there’ll be no trail of breadcrumbs to help us find our way back through the forest. One day you’ll blink and the NHS will have completely evaporated – and if that blink turns out to be a stroke then you’re totally screwed.

My opinion of private healthcare in the UK changed a bit during my time as a registrar. I used to be on board with it, seeing it as much like private schooling: a bunch of rich people who save the taxpayer a few quid by going off and doing their own thing, no harm done. I could always see myself doing the odd bit of private work as a consultant – one evening a week in clinic maybe, the occasional hysteroscopy list if I thought I deserved a Mercedes, perhaps a caesarean a month if I thought my Mercedes deserved a chauffeur. I knew consultants who had this life, and it didn’t hurt my motivation to imagine it for myself.

And then in my second year as a registrar I started doing regular locum work. I’d rather overstretched myself on the mortgage and it felt like a sensible way of making my income do at least a reasonable impression of my outgoings. As free time was in short supply (and what I had of it didn’t just feel like mine to give away), I generally took night shifts sandwiched between normal days at work and, in order to guarantee an hour or two of sleep, I would do them in private hospitals or private wings of NHS hospitals, where the workload is a lot lighter.

These days I get asked fairly often by friends who’ve made much better life choices than me about whether they should have their baby privately. These are people who order from the bottom of the wine list to get a better wine, or order from the bottom of the holiday home in the Chilterns list to get a better holiday home in the Chilterns. People who know that while money might not buy you happiness, it certainly buys you nicer stuff.

This theory, it turns out, doesn’t really work with childbirth. It’s a shame, because if you choose to go private you’ll be spunking around fifteen grand on it, and it won’t be covered by your health insurance. You’ll definitely get a nicer hospital room and nicer food. You’ll certainly get an elective caesarean if you ask for one. In fact, your consultant might actively encourage you to have one. They can bill you extra for it on top of the fifteen grand – plus they know they won’t get unexpectedly bleeped in the middle of a dinner party to pull a baby out of you. And if you start to bleed a few hours later, when your consultant is back home, the resident doctor will run along. When it was me, fine – I could deal with it, it was my day job. But I could see the rest of the rota; and a lot of my colleagues in private-locumland normally worked as SHOs, some of them extremely junior ones, and would be woefully under-equipped to deal with a situation like that.

But what if there’s a major emergency, beyond any single doctor’s capabilities? One where you need a team of obstetricians, anaesthetists, paediatricians, maybe even medics and surgeons from other specialities? Then all you can do is call 999, have your patient taken to an NHS unit designed to cope with this scenario and hope they live long enough to get there.

You can google the names of private maternity units alongside the words ‘out of court settlement’ if you want case studies. As I say, the food’s always excellent. Whether it’s to die for is your decision.

Personally, I didn’t ever want to risk being the doctor holding the ball when it all went wrong, so I bailed on private medicine after a few months of these shifts. Which was a bit of a shame as I’d already decided what colour uniform my chauffeur would wear.

* For now, at least.

Saturday, 9 August 2008

Non-medic friends are always impressed when I perform spot diagnoses on members of the public – like an advanced level of ‘I Spy’. The lady on the bus with early Parkinson’s, the man at the restaurant with lipodystrophy from HIV medication, the guy with the eye changes denoting high cholesterol, the characteristic flapping hand of liver disease, the fingernail changes of lung cancer.

But there’s clearly a time and a place. ‘Trichomonas Vaginalis,’ I say proudly, pointing out the telltale green discharge residue on the stripper’s vulva. And just like that, I’m ruining the stag do, apparently.

Monday, 11 August 2008

Moral maze. On a locum shift in a unit with some private labour ward rooms, and called in by the midwife to see a woman who is pushing and has a worrying trace. I let the patient know I need to give her baby a hand coming out because its heart rate has dropped quite a bit. I tell her there’s no time to wait for her consultant to come in, but it’s literally my bread and butter, and everything will be absolutely fine. She understands.

Out of the room I call her consultant, Mr Dolohov, a traditional courtesy with a private patient. He isn’t very courteous in response. He says he’s only a minute away and coming straight over: under no circumstances am I to deliver ‘his’ patient. I go back into the room and prepare everything for his arrival – forceps, delivery pack, suture set. And then I decide this is ridiculous; the baby is clearly unwell and will deteriorate every moment I don’t deliver it. What if he’s only a minute away like every minicab is ‘only a minute away’? If the baby comes out compromised because of my inaction, that’s my GMC number up the fuck. And worse, it’s a damaged baby. If this Mr Dolohov wants to complain about me, the worst that can happen is I never work again in a hospital I now have no desire to work in.

I deliver the baby – it takes a moment to breathe but soon perks up, and cord gases* confirm I was right not to wait. I deliver the placenta, stitch up a graze, clean up the patient and say, ‘Adam’s a good name.’ She’s calling it Barclay, naturally. Still no consultant. Moral maze correctly navigated.

I’ve already got changed into fresh scrubs by the time Mr Dolohov finally appears. To give him credit, he’s heard the cord gases from a midwife and gives me a huge apology. I’d have preferred it if he’d given me a huge sum of money, especially as he’ll be charging the patient thousands of pounds for the delivery that I did, but there you go.

* After the baby is born and handed over to the paediatricians, you take a sample of blood from the bit of umbilical cord attached to the placenta, known as ‘cord gases’. They get tested on a machine on labour ward and definitively show how urgently the baby needed to have been delivered.

Friday, 5 September 2008

‘Do you have a place?’ asked Mr Lockhart as I joined him in morning antenatal clinic. It took me a moment – we’d been talking about holidays, how I’d finally booked one and was off to France with H.

‘Yes . . . I mean, we’ve booked our tickets . . .’

‘No! A place! Do you have a little place there?’

How deliciously out of touch he was with the life of a registrar. I can barely afford the mortgage on a tiny flat despite our two incomes; a bolthole in France seems as likely a next move as buying a racehorse or a timeshare on the Death Star. But on the other hand, this is clearly a normal thing for a consultant to have – an aspirational light at the end of the registrar tunnel.

He apologizes for the fact that he’s going to have to leave clinic a little early today – in fact, he should probably leave now. There are fifty-two patients in clinic and I’m now the only doctor here. There may well be a light at the end of the tunnel, but the tunnel is eighty-five miles long, crammed full of impacted faeces, and I have to eat my way out of it.

Thursday, 11 September 2008

I almost cry at the end of an unforgiving night shift when I see my pigeonhole has something other than a nit-picking memo about parking or hand gel; it’s a lovely card from a patient. I remember her well. I repaired a tear she sustained a couple of weeks ago during a spontaneous vaginal delivery.

Dear Adam,

Just wanted to say thank you. You did a fantastic job – my GP checked my stitches and said you could hardly tell I’d had a baby, let alone a third-degree tear! I’m extremely grateful to you. Thank you again.

Everything about it is so thoughtful, the kind of thing that makes the whole job totally worthwhile. She’d even made it herself – beautiful textured white card adorned with her baby’s footprint in gold paint on the front. Then again, I guess she didn’t have much choice – there can’t be much call in Paperchase for ‘Thanks for mending my anus!’ cards.

Tuesday, 16 September 2008

In labour ward triage a woman is furious that three or four people who arrived after her have been seen before her. ‘If I ever have to go to hospital, madam,’ one of the midwives calmly tells her, ‘I want to be seen last. Because that means everyone else there is sicker than me.’

Thursday, 18 September 2008

My phone rings at 8 p.m. I try to guess whether it’s because I’ve forgotten to turn up for a night shift or someone else has failed to turn up for one and I’m about to get pulled back to the ward on my invisible bungee rope. Happily, it’s just my friend Lee, although he sounds rather worried. Lee is reliably my calmest, least flappable friend, so it’s alarming to say the least. He works as a criminal defence lawyer, and I regularly hear him talking on the phone with policemen, judges and the like, cheerily asking, ‘And was the whole body destroyed by the acid or just the skull?’ or ‘Roughly what size of genocide are we talking?’ He asks if I’m free to come over; his flatmate Terry has injured himself and Lee suspects he may benefit from going to hospital, but would value my advice. It’s not far away and I’m not doing anything that can’t wait, so I pop over.

Terry has indeed injured himself. From the most insignificant of actions can come the most serious of consequences – and we’ve gone full ‘butterfly effect’ here. He cut his thumb opening a humble can of beans, has severed a little artery that’s currently irrigating the floor and the top of his thumb is flapping open like a Muppet’s mouth. There’s even bone visible. I’m happy to provide my professional assessment that a visit to hospital is not just advised, but is both crucial and urgent. I suspect very few people in the world would disagree with me on this point. Unfortunately, Terry is one of them.

Lee takes me into the kitchen for a moment. Terry will take quite some persuading to go to hospital – he drinks rather heavily and worries that any blood tests will show liver damage and lead to a cascade of investigations and misery he has no interest in. It would also explain why he was bleeding so heavily and why the expression ‘blood is thicker than water’ didn’t seem to apply to him.*

I spend a short while trying to negotiate with Terry. I suggest the doctors will be too concerned with the fact half his thumb is hanging off to bother delving too far into anything else, but it’s clearly not a fight I’m going to win. He won’t even let me call an ambulance so they can come and assess him. I go back through to Lee to formulate a Plan B, while Terry ruins a couple more tea towels. Plan B comes quite easily. I’m a doctor, Lee’s a lawyer; between us we can section Terry under the Mental Health Act on the basis that he’s a risk to himself. Lee, clearly knowing rather more about the Mental Health Act than I do, points out that not only can we definitely not section a patient between us, but he wouldn’t be a candidate for it anyway, as he’s completely competent† to make the decision not to go to hospital.

Lee has a Plan C, which is presented to me in the form of a small crate of medical supplies. A year ago he took a holiday in Uganda (who actually does this?) and the advice given to plucky travellers is to buy one of these kits before you leave and keep it with you while you’re away. If you get hospitalized during the trip, they can use your equipment rather than theirs, and you’ll protect yourself from some hospitals’ slightly laissez-faire attitude to infection control and a dose of HIV.

Lee unseals the case, opens it out in front of me like a dodgy market trader and asks me if I have what I need to sew Terry back up. He clearly splashed out on the deluxe package – there’s probably enough kit in there to take out a lung. After a short while cooing over it like an auntie trying to find the hazelnut swirl in a box of Milk Tray, I select suture material, scissors, needle-holders, swabs and cleaning solution – the only thing missing is some local anaesthetic. Lee jokes that Terry can just bite down on a wooden spoon.

And so, five minutes later, I find myself operating on a remarkably up-for-it Terry at the kitchen table. I clean the wound, place some big deep stitches to try and stop the arterial bleeder, then start closing the thumb up in layers as soon as everything’s dry. The pain quickly gets a bit much for Terry to tolerate and – eager to keep his screams to a minimum (if the neighbours pop in to check everything’s OK, this will all take some explaining) – Lee hands him the wooden spoon. And it works remarkably well.

I soon close up the skin and am rather pleased with the cosmetic result. I’m not sure how receptive Terry is to my advice on wound care and removal of stitches, but I give it anyway while he shivers his thanks and reaches for a drink, resolving never to eat beans again. I quietly ask Lee about the medico-legal implications of the evening’s events. He laughs and swiftly changes the subject, packing me off in a cab with a nice bottle of rum. (Presumably Terry’s.)

On the way home, I realize Terry should probably have a few days of antibiotics, given the slightly backstreet nature of the procedure. I call Lee to make sure he sends Terry to the GP in the morning. I apologize for not writing a private prescription, but it’s against GMC guidance to prescribe for friends and family. I can hear Lee’s eyes rolling over the phone line. ‘I think that’s the least of your worries here.’

* Among the liver’s many and confusing functions, it produces a whole load of clotting factors, meaning that liver failure causes defective clotting.

† A patient is competent to make a decision if they can be demonstrated to understand the information they’re being presented with, retain that information and weigh up the pros and cons. Even if their decision is absolutely bananas.

Thursday, 16 October 2008

Handing over an extremely busy labour ward to a locum. We’ve been working flat-out all day, and it’s not going to be a quiet night either. There are a couple of women likely to end up with sections, a couple more heading towards instrumental delivery, plus a busy triage and A&E referrals Jenga-ing up. I apologize profusely – busy shifts are twice as difficult when you’re a locum and don’t know the peculiarities of a hospital. I can sense there’s all sorts of inner turmoil going on behind his eyes, but he says nothing.

I realize I may have made it sound a little too ghastly, so back-pedal slightly. ‘Room five might deliver normally, actually, and I don’t think there’s anything too urgent in A&E just now, so . . .’ This doesn’t seem to have done the trick – he still looks terrified. He asks me in broken English if he’s expected to do caesareans. I suspect he’s asking whether the SHO he’s on with can operate, and I explain that she’s very junior. But, no, he’s asking if he might have to do a caesarean tonight – he’s never done one before.

I ready myself for the explanation of what is clearly a hilarious misunderstanding. Maybe he’s meant to be working as a neurology registrar and has just turned up on the wrong ward, and our real locum – the one who can actually do what we need them to do – is just about to stroll in, blaming some confusing signage. Nope, this guy accepted a shift from the locum agency as an obstetric registrar and no one there or at the hospital bothered to ask whether he’d ever worked on a labour ward before.

I send him home and call the consultant to ask what to do, knowing full well the answer involves me working another twelve hours for free.

Monday, 20 October 2008

Patient HT has absolutely nothing wrong with her, physically at least. She’s had normal blood tests, normal swabs, a normal hysteroscopy and a normal laparoscopy. There’s no gynaecological (or any other kind of logical) cause for the pelvic pain she describes, and she’s had no benefit whatsoever from the myriad treatments we’ve tried.

She still insists it’s gynae. ‘I know my own body!’ She even knows the exact treatment she would like – for us to remove all of her pelvic organs. I and various colleagues and bosses have explained at length that we don’t think it will help her symptoms in the slightest – plus it would be a big operation that carries non-trivial risks, including the chance it would cause adhesions* and result in worsened pelvic pain. She’s adamant it’s the only answer ‘as I’ve been saying all along’, and won’t contemplate any options other than ripping out all of her plumbing. Maybe she’s run out of storage at home and just wants to clear some extra space?

It falls to me to finally discharge her from clinic and refer her to the pain management service, who will eventually get her on anti-depressants. This doesn’t go down well, and I get everything from ‘I’ve paid taxes all my life!’ to ‘Call yourself a doctor?’ plus a list of all the people she’s going to complain to, from the chief executive of the hospital to her MP. I tell her I appreciate her frustrations, but I really think we’ve done all we can for now. She asks me for a second opinion and I tell her she’s already seen a large number of our doctors, all of whom were of the same opinion.

‘I’m not leaving here until I’m booked in for this operation,’ she announces, hands folded in her lap, and she clearly means it. I don’t have time to wait for Satan to put on gloves and a North Face jacket, so I decide to book her in for another appointment in a few weeks’ time – throwing a colleague under the same bus I’ve just dodged the fare on. I’ve got no doubt she can, and will, waste this clinic’s resources for another year or more.

Before I offer her this appointment, she screams, ‘Why does no one take me seriously?!’ then picks up a sharps bin† and throws it at my head. I yelp, duck and constrict my anus to a one millimetre bore. The bin hits the wall above my desk and a shower of virulent needles rains down around me. Somehow, like Roadrunner escaping a Wile E. Coyote assassination attempt, they all miss me, and I avoid catching twelve strains of HIV. A nurse runs in to see what the kerfuffle is and then goes to phone security. And with that the patient is discharged from clinic. Next!

* Adhesions are bands of internal scar tissue, caused by previous operations or sometimes infections. They can cause pain for the patient, and also make subsequent operations much harder by gunking together all the organs. It’s not always perfectly laid out in there like steaks and sausages on an OCD barbecue, you know.

† Every office has separate bins for general rubbish, paper, plastics, etc., for everyone to ignore. In medical settings we also have the sharps bin – rigid plastic sweet tubs where you dispose of used needles, blades, lancets and the like.

Thursday, 6 November 2008

I have lost a pen. Or more accurately, my pen has been stolen. Or even more accurately, it has been stolen by one of the three people in delivery room five: patient AG, her boyfriend or her mother. I wouldn’t mind so much were it not a birthday present from H, were it not a Montblanc and had I not just delivered their baby.

The labour itself was without serious incident but they’ve been aggressive throughout my time with them and their feral snarling matched with the considerable tattoo count – baby excluded, for now – makes me slightly reluctant to accuse them of larceny.

I guess I’m lucky to have made it this many years without something getting pinched. Colleagues have had everything from scrub pockets picked, bags nicked from the nursing station and lockers broken into; not to mention tyres slashed in hospital car parks and even the odd physical assault.

I have a moan to Mr Lockhart, who I wouldn’t trust to cut a patient’s toenails, but is always good for a bit of advice and an anecdote. The advice was to forget it, don’t get stabbed, and fair play to the patient for recognizing a decent pen. Then he got started on the anecdote.

Before his career in obs and gynae, Mr Lockhart worked as a GP in South London for a short chunk of the seventies. He celebrated getting a permanent job in general practice by buying himself a bright blue MGB convertible. The car was his pride and joy: he talked about it constantly to patients, friends and colleagues; waxed and polished it every weekend; only just stopped short of having a photo of it on his desk. And then one day it was over, as happens with all one-sided love affairs, when he finished surgery and clocked that the bright blue MGB convertible was missing from the surgery car park. He called the police, who did all they could, but ultimately failed to find the car. Lockhart’s topic of conversation with patients, friends and colleagues now switched to the wretched state of the world – how could someone steal his beautiful car?

One day he was telling his tale of woe to a patient, who turned out to be a high-ranking member of what amounted to a local family of gangsters and, thanks to that bizarre moral code criminals seem to hold dear, was disgusted by this. What kind of lowlife would steal a doctor’s car? Absolutely unacceptable. He said he was sure he’d be able to identify the felon and persuade them to return the car, though Mr L of course said there was absolutely no need – the same way you would claim there was ‘absolutely no need’ for someone to buy you an all-expenses-paid trip to the Seychelles. In other words, ‘go on then’.

Later that week, Lockhart arrived at work to find a bright blue MGB convertible in the car park, its keys on the dashboard. His overwhelming relief turned to more mixed emotions at the realization that the car had a completely different number plate and interior.

Saturday, 15 November 2008

An email from Mme Mathieu telling me, with great regret, she’s refunding the rest of the term’s fee for my Conversational French class because I’ve now missed so many lessons it’s pointless coming back. Email correspondence with Mme Mathieu is usually conducted entirely in French to fully immerse us in the language. This is the first email I’ve had from her in English; she’s clearly not confident I’d understand otherwise, which really rubs sel into whatever the French for ‘wound’ is.

Monday, 17 November 2008

Superstition dictates you can’t ever describe a shift as ‘quiet’. Much like you don’t say ‘good luck’ to an actor or ‘go fuck yourself’ to Mike Tyson. Say the Q word to a doctor and you’re all but performing an incantation, summoning the sickest patients in the world to your hospital. I turn up for a locum night shift on a private obstetric unit and the registrar lets me know it should be ‘very quiet tonight’. Before I have time to flick water at her and rattle off a few ‘THE POWER OF CHRIST COMPELS YOU!’s she tells me a high-ranking royal from a Gulf state has just delivered a baby on labour ward, which goes some way to explaining the Oscars-level security everywhere and all the suede Ferraris outside.

As far as I’m concerned, roping off three tables in All Bar One for a twenty-first birthday is ‘a bit swanky’, but our esteemed guests have not only booked out the entire maternity unit so there’s not a single other patient around, but their consultant will be staying overnight as well, just in case. It was fair to say the shift was quiet.

Tuesday, 18 November 2008

Ron phoned me for some medical advice this evening. His dad has been losing a lot of weight and having mid-chest discomfort and increasing difficulty in swallowing. When he went to his local surgery about it this morning, the GP thought he was looking a little yellow around the gills and referred him to be seen by gastro within the week. What did I think was going on?

If I was being asked on an exam paper, I’d have said it was metastatic oesophageal cancer with a survival rate of zero per cent. If I was being asked by a patient I’d have said it was very worrying and we’d want to investigate extremely urgently to rule out the possibility of cancer.

But if I’m asked by someone close to me? I said it sounded like his GP was doing everything right (true), and that it still could be nothing (definitely untrue – there was no plausible version of events where this was anything other than a very bad something). I desperately wanted it to be OK – for Ron and for his dad, who I’ve known since I was eleven – so I lied. You never lie to your patients to give them false hope, but there I was doing exactly that, reassuring my mate that everything would be fine.

We’re constantly reminded by the GMC not to be doctor to friends or family, but I’ve always just ignored that and provided them an on-call private service. Because my job makes me such a useless friend in so many ways, I guess I feel like I have to offer something to justify my name on their Christmas card list. And this is basically why we’re taught not to.

Thursday, 20 November 2008

In no other job would you be expected to wear shoes from a communal supply on a ‘first come, first served’ basis. It’s like being at a Megabowl where people constantly get splashed with amniotic fluid, blood and placental tissue, and everyone’s too lazy to clean them afterwards.

If you want your own personal white leather hospital clogs they cost around £80, so it’s previously only consultants who’ve splurged on them, gliding around the hospital like they’ve got two giant paracetamols on their feet. But now there’s a new breed of shoes called Crocs – they come in bright colours, do the same job and cost less than twenty quid. They have the added advantage of having holes in them, so you can padlock your pair together and no other bastard will get their hands or verrucas on them.

Today a notice has appeared in the changing rooms: ‘Staff must under no circumstances wear Crocs footwear as the holes do not provide adequate protection from falling sharps.’ A frustrated personal stylist has added underneath, ‘And they make you look like a douche’.*

* Presumably the same wag who changed the sign that says ‘Warning! Thieves are operating in this department!’ to ‘Warning! Surgeons are operating in this department!’

Saturday, 22 November 2008

Called to A&E to review a nineteen-year-old girl with heavy vaginal bleeding – same old, same old. What I’m in fact faced with is a nineteen-year-old girl who has taken kitchen scissors and performed her own labial reduction surgery. She valiantly managed to chop three-quarters of the way down her left labium minus before she called a) it a day, and b) an ambulance. It was an absolute mess down there, and bleeding heavily. I checked with my senior registrar that I wouldn’t inadvertently be performing female genital mutilation and go to prison if I cut off the loose end and over-sewed the bleeding edge. All fine, and I tidied it up. In honesty, she didn’t do much of a worse job than a lot of labiaplasties I’ve seen.

I booked her into gynae outpatients for a few weeks’ time and we had a bit of a chat, emergency now out of the way. She told me she ‘didn’t think it would bleed’, to which I didn’t have anything to helpfully reply, and that she ‘just wanted to look normal’. I reassured her there was absolutely nothing wrong with her labia; they really, honestly, did look normal. ‘Not like in porn though,’ she said.

There’s been a lot of media noise about the damaging effects of porn and glossy magazines on body image, but this is the first time I’ve seen it first-hand – it’s horrifying and depressing in equal parts. How long until we’re seeing girls stapling their vaginas tighter?*

* The answer, as it turns out, was a year. A colleague saw a patient who’d superglued the introitus of her vagina because her boyfriend had been pressuring her to.

Wednesday, 10 December 2008

This week the hospital are running a diary card exercise.* I presume that in normal jobs they monitor employees because staff are working fewer hours than they’re paid for.

Consultants never previously spotted on a ward are seen writing discharge summaries for patients, working a few hours in labour ward triage, reviewing patients in A&E – to maximize the chance of the juniors leaving on time. This will continue until the nanosecond the diary card exercise ends, of course, but for now I’m enjoying the rewards. It’s my third consecutive shift leaving on time, prompting H to sit me down and ask if I’ve been sacked.

To ensure the illusion of accuracy, clerical staff from hospital management shadow a few doctors at random during their shifts. I was joined by one on a night shift – or at least until 10.30 p.m. when she went home, unironically announcing she was exhausted.

* During a diary card exercise, every doctor has to record their exact hours worked. But because the hospital can’t (or don’t want to) pay us for the time we actually work, they render the process completely meaningless. Either they lean on us to lie in the diary cards and just record our contracted hours or they throw dozens of consultants onto the wards to temporarily ease the burden on the juniors.

Monday, 29 December 2008

Seeing a patient in gynae clinic whose GP recently started her on HRT patches and now has some PV bleeding. I ask her how long she’s been on the HRT and she lifts up her blouse and counts the patches. ‘Six . . . seven . . . eight weeks.’ Her GP hadn’t explained that she has to take the old ones off.

Saturday, 10 January 2009

Percy and Marietta’s wedding today felt like a huge triumph against the odds. Not one, but two doctors able to get their big day off work. And the whole day too, not like my former colleague Amelia, who could only wangle the afternoon of her wedding day off, and ended up conducting her morning clinic in full hair and makeup to make the timings work.

The main miracle is they’ve managed to last this long together, despite a system seemingly designed to ruin their relationship. Percy and Marietta got their training posts in different deaneries, meaning the closest hospitals they could possibly work at over the course of five years were 120 miles apart. Rather than live together somewhere mutually inconvenient, Percy moved out to live in awful hospital accommodation and pop back home when the rota allowed, which it generally didn’t.

In his speech, the best man, Rufus, a surgical trainee, compared their set-up to having a partner who works on the International Space Station. It was a brilliant speech, made all the more poignant because Rufus had to deliver it between the starter and main course. As soon as the pan-seared chicken livers were wolfed down, he had to dash off for a night shift.

Monday, 12 January 2009

Asked to review a patient in labour ward triage and repeat a PV as the midwife is uncertain of her findings. Her findings were of cephalic presentation with cervix 1 cm dilated. My findings are of breech presentation, cervix 6 cm dilated. I explain to mum that baby is bottom-down and the safest thing to do is to deliver by caesarean section. I don’t explain to mum which part of the baby the midwife has just stuck her finger in to 1 cm dilatation.

Thursday, 22 January 2009

I accidentally dropped the on-call bleep into the labour ward macerator this evening, sending it off to a crunchy death. A feeling very similar to pissing your jeans – that wonderful warm sensation of enormous relief, followed almost immediately with, ‘Fuck, what do I do now?!’

Thursday, 29 January 2009

Waited about a minute before making the uterine incision at caesarean until Heart FM had moved on to the next song. As appropriate as Cutting Crew may be for a surgeon, I refuse to deliver a baby to the refrain of ‘I just died in your arms tonight’.

Friday, 30 January 2009

Patient DT is twenty-five years old and has attended colposcopy clinic* for her first smear test. And her second smear test: she has complete uterus didelphys – two vaginas, two cervices, two uteri. I’ve never seen this before. I perform both smears and spend a minute or two working out how the fuck to label the slides and forms, as the NHS cervical screening programme isn’t really equipped for this admittedly rare scenario.

She’s not seen a gynaecologist since she was a teenager so has a bunch of questions for me. I admit I’ve never come across a case like hers before, but answer the questions as best I can. She’s mostly worried about future pregnancies.† I ask if she’d mind some questions in return. Potentially inappropriate, but we had a good rapport, and I’ll probably never get the opportunity to chat to someone with the condition again.

Here’s what I learned. She used to mention it to guys before they had sex, which tended to freak them out, so now she doesn’t mention it at all. They apparently never notice in any case, which is hardly surprising – most guys’ knowledge of female genital anatomy is sketchy at best. Aside from the old ‘finding the clitoris’ cliché, many don’t seem to realize girls have a separate hole for peeing – they just think it’s one great multi-functioning service tunnel. More than once I’ve catheterized a woman during labour only for her partner to ask if that isn’t going to stop the baby from coming out.

The patient tells me she prefers having sex with her left vagina, as it’s bigger (as I’d noted during examination – the right needed a smaller speculum), although she says it’s nice to have an option for ‘different sizes of guys’. I suggest that if she forgets which way round it is, the mnemonic ‘righty tighty, lefty loosey’ would apply – though in truth she’s probably very unlikely to forget which way round her vaginas are.

I recount my tale to H after work. ‘So it’s like one of those metal pencil sharpeners at school with two sizes of hole?’

* Colposcopy is a fancier way of doing smear tests – having a look at the neck of the womb for pre-cancer cells.

† She’s likely to be able to get pregnant, but there’s increased chance of late miscarriage, premature birth, growth restriction and breech presentation, and she’s much more likely to be delivered by caesarean.

Tuesday, 3 February 2009

Last day at work before moving on to our next postings. It always feels odd to leave a job where you’ve watched lives begin and end, spent more hours than at your own house, seen the ward clerk more than your partner, and have your departure go all but unacknowledged – but I’ve hardened to it by now. There’s such an extraordinary turnover of junior doctors that I understand why there’s no great fanfare. As a particularly venomous matron once hissed at us, ‘You are temporary visitors at my permanent place of work.’

I’ve never once had a goodbye card, let alone a present. Until today, when I found a package in my pigeonhole from Mr Lockhart. A card to say thank you and goodbye, and a brand new Montblanc pen.